Pandemic Policy Design Via Feedback: A Modelling Study

BackgroundThe COVID-19 pandemic has had an enormous toll on human health and well-being and led to major social and economic disruptions. Public health interventions in response to burgeoning case numbers and hospitalizations have repeatedly bent down the epidemic curve in many jurisdictions, effectively creating a closed-loop dynamic system. We aim to formalize and illustrate how to incorporate principles of feedback control into pandemic projections and decision making.MethodsStarting with a SEEIQR epidemiological model, we illustrate how feedback control can be incorporated into pandemic management using a simple design (proportional-integral or PI control), which couples recent changes in case numbers or hospital occupancy with explicit policy restrictions. We then analyse a closed-loop system between the SEEIQR model and the designed feedback controller to illustrate the potential benefits of pandemic policy design that incorporates feedback.FindingsWe first explored a feedback design that responded to hospital measured infections, demonstrating robust ability to control a pandemic despite simulating large uncertainty in reproduction number R 0 (range: 1.04-5.18) and average time to hospital admission (range: 4-28 days). The second design compared responding to hospital occupancy to responding to case counts, showing that shorter delays reduced both the cumulative case count and the average level of interventions. Finally, we show that feedback is robust to changing public compliance to public health directives, and to systemic changes associated with new variants of concern and with the introduction of a vaccination program.InterpretationThe negative impact of a pandemic on human health and societal disruption can be reduced by coupling models of disease propagation with models of the decision-making process. This creates a closed-loop system that better represents the coupled dynamics of a disease and public health responses. Importantly, we show that feedback control is robust to delays in both measurements and responses, and to uncertainty in model parameters and the efficacy of control measures.